{"id":6411,"date":"2026-04-01T18:35:46","date_gmt":"2026-04-01T15:35:46","guid":{"rendered":"https:\/\/wiki.voka.io\/diseases\/uncategorized\/stenose-mitrale\/"},"modified":"2026-04-16T13:54:48","modified_gmt":"2026-04-16T10:54:48","slug":"stenose-mitrale","status":"publish","type":"diseases_post","link":"https:\/\/wiki.voka.io\/fr\/maladies\/cardiologie\/stenose-mitrale\/","title":{"rendered":"St\u00e9nose mitrale&nbsp;: \u00e9tiologie, pathog\u00e9nie, sympt\u00f4mes, diagnostic et m\u00e9thodes de traitement"},"content":{"rendered":"<p>La st\u00e9nose mitrale (SM) est un r\u00e9tr\u00e9cissement pathologique de l\u2019orifice mitral qui entra\u00eene une alt\u00e9ration du remplissage diastolique du ventricule gauche, ainsi qu\u2019une augmentation de la pression dans l\u2019atrium gauche et la circulation pulmonaire.<\/p>\n<p>Dans les pays d\u00e9velopp\u00e9s, la st\u00e9nose mitrale est rare et principalement li\u00e9e \u00e0 des ant\u00e9c\u00e9dents de rhumatisme articulaire aigu, tandis que dans les r\u00e9gions en d\u00e9veloppement, elle reste une cause importante d\u2019atteintes valvulaires. Les femmes sont plus souvent touch\u00e9es par cette pathologie que les hommes. Les sympt\u00f4mes se manifestent g\u00e9n\u00e9ralement au bout de 10 \u00e0 30\u00a0ans.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/1-mitral-valve-normal.webp\" alt=\"Valve mitrale normale. 1&nbsp;\u2013 feuillet post\u00e9rieur, 2&nbsp;\u2013 feuillet ant\u00e9rieur, 3&nbsp;\u2013 muscle papillaire ant\u00e9ro-lat\u00e9ral, 4&nbsp;\u2013 muscle papillaire post\u00e9ro-m\u00e9dial\"><figcaption class=\"wp-element-caption\">Valve mitrale normale. 1\u00a0\u2013 feuillet post\u00e9rieur, 2\u00a0\u2013 feuillet ant\u00e9rieur, 3\u00a0\u2013 muscle papillaire ant\u00e9ro-lat\u00e9ral, 4\u00a0\u2013 muscle papillaire post\u00e9ro-m\u00e9dial\u00a0\u2013 <a href=\"https:\/\/catalog.voka.io\/en\/models\/d1df170c-51ef-4d23-93b5-0380d03866e5\/befbeb9a-0f4f-437b-ae62-98b234d86334\/8ccb3047-bff0-4e2e-8402-2a4c56b66488\/e72e5fce-4895-4c18-9978-b12998dcd92c\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Mod\u00e8le\u00a03D<\/a><\/figcaption><\/figure>\n<h2 class=\"wp-block-heading\" id=\"etiologie-de-la-stenose-mitrale\">\u00c9tiologie de la st\u00e9nose mitrale<\/h2>\n<ul class=\"wp-block-list\">\n<li><strong>Cardiopathie rhumatismale<\/strong>\u00a0: principale cause de la st\u00e9nose mitrale (environ 90\u00a0% des cas). Dans les pays dot\u00e9s de syst\u00e8mes de sant\u00e9 avanc\u00e9s, on observe une diminution de l\u2019incidence des st\u00e9noses rhumatismales.<\/li>\n<\/ul>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/2-rheumatic-mitral-stenosis.webp\" alt=\"St\u00e9nose rhumatismale de la valve mitrale\"><figcaption class=\"wp-element-caption\">St\u00e9nose rhumatismale de la valve mitrale\u00a0\u2013 <a href=\"https:\/\/catalog.voka.io\/en\/models\/d1df170c-51ef-4d23-93b5-0380d03866e5\/4c087bf8-9aea-42db-8481-bcf40a34fc93\/93904017-aecc-44b2-9535-94be1533a1cc\/b9dbb18a-0fd7-4cc9-8765-4c9c00739a16\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Mod\u00e8le\u00a03D<\/a><\/figcaption><\/figure>\n<ul class=\"wp-block-list\">\n<li><strong>St\u00e9nose d\u00e9g\u00e9n\u00e9rative<\/strong>\u00a0: associ\u00e9e \u00e0 une calcification de l\u2019anneau mitral. Deuxi\u00e8me cause la plus r\u00e9pandue. Fr\u00e9quente chez les patients \u00e2g\u00e9s.<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Valvulopathie radio-induite<\/strong>\u00a0: se d\u00e9veloppe 10 \u00e0 20\u00a0ans apr\u00e8s une radioth\u00e9rapie m\u00e9diastinale. Elle est due \u00e0 une fibrose et \u00e0 un \u00e9paississement des structures valvulaires.<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Formes cong\u00e9nitales<\/strong> de st\u00e9nose mitrale\u00a0: rares, se manifestent g\u00e9n\u00e9ralement pendant l\u2019enfance. <\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Maladies infiltratives et syst\u00e9miques <\/strong>(maladie de Fabry, mucopolysaccharidoses, cardiopathie carcino\u00efde, fibrose endomyocardique, lupus \u00e9ryth\u00e9mateux diss\u00e9min\u00e9, etc.)\u00a0: causes extr\u00eamement rares.<\/li>\n<\/ul>\n<p>Il convient de distinguer la st\u00e9nose vraie de l\u2019obstruction du flux mitral d\u2019origine non valvulaire, observ\u00e9e en cas de myxome de l\u2019atrium gauche, de thrombose, de v\u00e9g\u00e9tations infectieuses volumineuses ou de d\u00e9g\u00e9n\u00e9rescence d\u2019une bioproth\u00e8se mitrale.<\/p>\n<h2 class=\"wp-block-heading\" id=\"pathogenese\">Pathogen\u00e8se<\/h2>\n<h3 class=\"wp-block-heading\" id=\"modifications-valvulaires-et-anatomiques\">Modifications valvulaires et anatomiques<\/h3>\n<ul class=\"wp-block-list\">\n<li><strong>Dans la cardiopathie rhumatismale<\/strong>, une inflammation chronique \u00e0 m\u00e9diation immunitaire entra\u00eene une fibrose des feuillets, une fusion des commissures, un \u00e9paississement et un raccourcissement des cordages. Il en r\u00e9sulte un r\u00e9tr\u00e9cissement central de l\u2019orifice mitral avec un bombement en d\u00f4me des feuillets. Avec le temps, le flux turbulent accentue la calcification et la rigidit\u00e9 valvulaire, ce qui renforce la st\u00e9nose.<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>En cas de d\u00e9g\u00e9n\u00e9rescence calcaire de l\u2019anneau mitral<\/strong>, la fibrocalcification s\u2019\u00e9tend de l\u2019anneau \u00e0 la base des feuillets, limitant ainsi leur mobilit\u00e9 sans fusion commissurale typique.<\/li>\n<\/ul>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/3-degenerative-mitral-valve-stenosis.webp\" alt=\"St\u00e9nose mitrale d\u00e9g\u00e9n\u00e9rative\n\"><figcaption class=\"wp-element-caption\">St\u00e9nose mitrale d\u00e9g\u00e9n\u00e9rative\u00a0\u2013 <a href=\"https:\/\/catalog.voka.io\/en\/models\/d1df170c-51ef-4d23-93b5-0380d03866e5\/4c087bf8-9aea-42db-8481-bcf40a34fc93\/93904017-aecc-44b2-9535-94be1533a1cc\/73a868aa-da7b-42ba-91ee-5f3d71501087\">Mod\u00e8le\u00a03D<\/a><\/figcaption><\/figure>\n<h3 class=\"wp-block-heading\" id=\"troubles-hemodynamiques\">Troubles h\u00e9modynamiques<\/h3>\n<ol class=\"wp-block-list\">\n<li>Le r\u00e9tr\u00e9cissement de l\u2019orifice mitral provoque une augmentation du gradient de pression diastolique entre l\u2019atrium gauche et le ventricule gauche.<\/li>\n<li>Une surcharge chronique augmente la pression dans l\u2019atrium gauche<strong>. <\/strong>La diminution progressive de la surface valvulaire limite le remplissage du ventricule gauche et r\u00e9duit le d\u00e9bit cardiaque.<\/li>\n<li>Une surcharge de pression prolong\u00e9e entra\u00eene une dilatation, une hypertrophie et une fibrose de l\u2019atrium gauche, contribuant au d\u00e9veloppement d\u2019une fibrillation atriale et cr\u00e9ant les conditions propices \u00e0 une thrombose intra-atriale.<\/li>\n<li>L\u2019augmentation de la pression dans l\u2019atrium gauche se transmet aux veines et capillaires pulmonaires, provoquant ainsi une hypertension pulmonaire post-capillaire et un remodelage des vaisseaux pulmonaires.<\/li>\n<li>La progression de la maladie conduit \u00e0 une surcharge du ventricule droit, \u00e0 une insuffisance ventriculaire droite et \u00e0 une r\u00e9gurgitation tricuspidienne fonctionnelle.<\/li>\n<\/ol>\n<h2 class=\"wp-block-heading\" id=\"manifestations-cliniques\">Manifestations cliniques<\/h2>\n<ul class=\"wp-block-list\">\n<li><strong>Phase asymptomatique prolong\u00e9e<\/strong>\u00a0;<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Dyspn\u00e9e <\/strong>\u00e0 l\u2019effort, puis au repos. Avec la progression de la maladie, une orthopn\u00e9e et des crises d\u2019\u00e9touffement nocturnes sont possibles\u00a0;<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Diminution de la tol\u00e9rance \u00e0 l\u2019effort et fatigue<\/strong>\u00a0: associ\u00e9es \u00e0 une r\u00e9duction du d\u00e9bit cardiaque et du remplissage diastolique du ventricule gauche\u00a0;<\/li>\n<li><strong>Fibrillation atriale<\/strong>\u00a0: peut \u00eatre le premier signe clinique de la maladie. Elle entra\u00eene souvent une d\u00e9gradation brutale de l\u2019h\u00e9modynamique due \u00e0 la tachycardie et \u00e0 la perte de la contribution atriale au remplissage ventriculaire\u00a0;<\/li>\n<\/ul>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/atrial-fibrillation-ecg-example.webp\" alt=\"Exemple de fibrillation atriale sur un ECG\"><figcaption class=\"wp-element-caption\">Exemple de fibrillation atriale sur un ECG<\/figcaption><\/figure>\n<ul class=\"wp-block-list\">\n<li><strong>H\u00e9moptysie\u00a0<\/strong>: cons\u00e9quence d\u2019une hypertension pulmonaire et de la rupture des veines bronchiques\u00a0;<\/li>\n<li><strong>Embolies syst\u00e9miques<\/strong>\u00a0: r\u00e9sultent du risque \u00e9lev\u00e9 de formation de thrombus dans l\u2019atrium gauche\u00a0;<\/li>\n<li><strong>Signes d\u2019insuffisance ventriculaire droite<\/strong>\u00a0: \u0153d\u00e8mes des membres inf\u00e9rieurs, ascite, etc.\u00a0;<\/li>\n<li><strong>Enrouement de la voix <\/strong>(syndrome d\u2019Ortner)\u00a0: d\u00fb \u00e0 la compression du nerf laryng\u00e9 r\u00e9current par l\u2019atrium gauche dilat\u00e9.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\" id=\"diagnostic-de-la-stenose-mitrale\">Diagnostic de la st\u00e9nose mitrale<\/h2>\n<p>Il n\u2019existe pas de marqueurs biologiques sp\u00e9cifiques. Le BNP \/ NT-proBNP permet d\u2019\u00e9valuer le degr\u00e9 d\u2019insuffisance cardiaque.<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>\u00c9chocardiographie transthoracique (ETT)<\/strong>\u00a0: m\u00e9thode cl\u00e9 pour le diagnostic de la st\u00e9nose mitrale.\n<ul class=\"wp-block-list\">\n<li><strong>\u00c9valuation morphologique\u00a0: <\/strong>\u00e9paississement et fusion partielle des feuillets\u00a0; raccourcissement et fibrose des cordages\u00ad; mobilit\u00e9 limit\u00e9e des feuillets, bombement en d\u00f4me du feuillet ant\u00e9rieur en diastole\u00a0; dimensions de l\u2019atrium gauche, pr\u00e9sence de thrombus intra-atriaux\u00a0; \u00e9tat du c\u0153ur droit.<\/li>\n<li><strong>Classification selon la surface effective de l\u2019orifice<\/strong> (\u2264\u00a01,0\u00a0cm<sup>2<\/sup>\u00a0\u2013 st\u00e9nose importante \u00e0 haut risque, \u2264\u00a01,5\u00a0cm<sup>2<\/sup>\u00a0\u2013 st\u00e9nose s\u00e9v\u00e8re, >\u00a01,5\u00a0cm<sup>2<\/sup>\u00a0\u2013 st\u00e9nose sans incidence h\u00e9modynamique). <\/li>\n<li><strong>Gradient transmitral moyen<\/strong>\u00a0: en cas de st\u00e9nose s\u00e9v\u00e8re, sup\u00e9rieur \u00e0 10\u00a0mmHg. p.<\/li>\n<li><strong>\u00c9valuation Doppler<\/strong>\u00a0: permet de mesurer la vitesse du flux transmitral, de calculer les gradients maximal et moyen, d\u2019\u00e9valuer la pression systolique dans l\u2019art\u00e8re pulmonaire \u00e0 partir du flux de r\u00e9gurgitation tricuspidienne, et de d\u00e9tecter une r\u00e9gurgitation mitrale associ\u00e9e.<\/li>\n<\/ul>\n<\/li>\n<li><strong>\u00c9chocardiographie de stress<\/strong> (effort physique ou dobutamine)\u00a0: r\u00e9alis\u00e9e en cas de discordance entre la s\u00e9v\u00e9rit\u00e9 des sympt\u00f4mes et les r\u00e9sultats de l\u2019ETT au repos. L\u2019examen permet d\u2019\u00e9valuer l\u2019\u00e9l\u00e9vation du gradient transmitral et de l\u2019hypertension pulmonaire.<\/li>\n<li><strong>\u00c9chocardiographie trans\u0153sophagienne (ETO)<\/strong>\n<ul class=\"wp-block-list\">\n<li>Elle permet d\u2019\u00e9valuer la morphologie des feuillets et des commissures.<\/li>\n<li>L\u2019examen est r\u00e9alis\u00e9 avant une valvuloplastie mitrale percutan\u00e9e afin d\u2019exclure la pr\u00e9sence d\u2019un thrombus dans l\u2019atrium et l\u2019auricule gauches, ainsi que pour pr\u00e9ciser le degr\u00e9 de r\u00e9gurgitation mitrale apr\u00e8s l\u2019intervention.<\/li>\n<li>Un \u00e9cho-contraste spontan\u00e9 dans l\u2019atrium gauche est un marqueur d\u2019une stase sanguine importante et d\u2019un risque thrombo-embolique \u00e9lev\u00e9, souvent associ\u00e9 \u00e0 une petite surface de l\u2019orifice mitral et \u00e0 un gradient \u00e9lev\u00e9.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Angio-TDM<\/strong>\u00a0: utile pour \u00e9valuer l\u2019anatomie du thorax, l\u2019\u00e9tat de l\u2019aorte et des vaisseaux des membres inf\u00e9rieurs, ainsi que pour choisir la voie d\u2019abord lors de la planification d\u2019une chirurgie mitrale.<\/li>\n<li><strong>Cath\u00e9t\u00e9risme invasif<\/strong>\u00a0: rarement utilis\u00e9\u00a0; indiqu\u00e9 en cas de donn\u00e9es non invasives contradictoires.<\/li>\n<\/ul>\n<div class=\"social-banner-block\">\n<div class=\"social-banner-content\">\n<p class=\"h5-title text-black\">Retrouvez d\u2019autres contenus scientifiquement exacts sur nos m\u00e9dias sociaux<\/p>\n<p><span class=\"social-banner-text text-grey\">Abonnez-vous et ne manquez pas les derni\u00e8res ressources<\/span><\/p>\n<div class=\"social-links-wrapper\"><a class=\"social-icon-link\" href=\"https:\/\/www.facebook.com\/VOKA3DAnatomyAndPathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/facebook.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.instagram.com\/voka.io\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/insta.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.linkedin.com\/company\/voka-io\/posts\/?feedView=all\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/linkedin.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.youtube.com\/@vokaio\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/youtube.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.pinterest.com\/voka3danatomyandpathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/pinterest.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.tiktok.com\/@voka.io\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/tiktok.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/discord.gg\/7ejUpq8DRR\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/discord.svg\" alt=\"social link\"><\/a><\/div>\n<\/div>\n<p><img decoding=\"async\" class=\"social-banner-image\" loading=\"lazy\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/social-media-banner-mobile-image.webp\" alt=\"Banner background\"><\/div>\n<h2 class=\"wp-block-heading\" id=\"traitement\">Traitement<\/h2>\n<h3 class=\"wp-block-heading\" id=\"traitement-medicamenteux\">Traitement m\u00e9dicamenteux<\/h3>\n<p>Le traitement m\u00e9dicamenteux ne supprime pas l\u2019obstruction, mais il permet de contr\u00f4ler les sympt\u00f4mes, de stabiliser l\u2019h\u00e9modynamique, de g\u00e9rer les complications et de pr\u00e9parer l\u2019intervention chirurgicale.<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>Diur\u00e9tiques<\/strong>\n<ul class=\"wp-block-list\">\n<li>Les diur\u00e9tiques de l\u2019anse (furos\u00e9mide)\u00a0r\u00e9duisent la congestion pulmonaire et les sympt\u00f4mes de dyspn\u00e9e\u00a0;<\/li>\n<li>Ils sont efficaces en cas d\u2019hypertension pulmonaire et d\u2019insuffisance ventriculaire droite\u00a0;<\/li>\n<li>Une diur\u00e8se accrue peut r\u00e9duire le d\u00e9bit cardiaque et accentuer la sensation de fatigue.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Contr\u00f4le de la fr\u00e9quence cardiaque<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>B\u00eata-bloquants<\/strong>\u00a0: m\u00e9dicaments de premi\u00e8re intention\u00a0; allongent la diastole et r\u00e9duisent le gradient transmitral\u00a0;<\/li>\n<li><strong>Inhibiteurs calciques non dihydropyridiniques<\/strong> (v\u00e9rapamil, diltiazem)\u00a0: alternative en cas de contre-indications aux b\u00eata-bloquants\u00a0;<\/li>\n<li><strong>Ivabradine\u00a0<\/strong>: peut \u00eatre utilis\u00e9e en rythme sinusal en cas d\u2019intol\u00e9rance aux b\u00eata-bloquants\u00a0; r\u00e9duit la fr\u00e9quence cardiaque sans effet inotrope n\u00e9gatif.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Digoxine<\/strong>\u00a0: envisageable chez les patients atteints de fibrillation atriale, de fr\u00e9quence cardiaque non contr\u00f4l\u00e9e ou de dysfonction systolique associ\u00e9e.<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Fibrillation atriale<\/strong>\n<ul class=\"wp-block-list\">\n<li>La perte de la contribution atriale et la tachycardie associ\u00e9es \u00e0 une st\u00e9nose mitrale entra\u00eenent rapidement un \u0153d\u00e8me pulmonaire\u00a0;<\/li>\n<li>En cas d\u2019instabilit\u00e9 h\u00e9modynamique, une cardioversion \u00e9lectrique est n\u00e9cessaire.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Traitement anticoagulant<\/strong>\n<ul class=\"wp-block-list\">\n<li>Il est indiqu\u00e9 chez les patients atteints de st\u00e9nose mitrale et de fibrillation atriale, ainsi que chez ceux pr\u00e9sentant un thrombus dans l\u2019atrium gauche et\/ou l\u2019auricule gauche ou ayant subi une embolie, quel que soit le rythme cardiaque\u00a0;<\/li>\n<li>En l\u2019absence de donn\u00e9es probantes suffisantes concernant les anticoagulants oraux, le traitement de choix reste un antagoniste de la vitamine\u00a0K (warfarine) avec un INR cible de\u00a02,0 \u00e0\u00a03,0.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"traitement-endovasculaire-valvuloplastie-mitrale-percutanee-par-ballonnet\">Traitement endovasculaire (valvuloplastie mitrale percutan\u00e9e par ballonnet) <\/h3>\n<p>La valvuloplastie mitrale percutan\u00e9e (VMP) par ballonnet est la m\u00e9thode de choix chez les patients atteints de st\u00e9nose mitrale rhumatismale et pr\u00e9sentant une anatomie valvulaire favorable.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/percutaneous-balloon-mitral-valvuloplasty-image.webp\" alt=\"Repr\u00e9sentation sch\u00e9matique de la valvuloplastie mitrale percutan\u00e9e par ballonnet\"><figcaption class=\"wp-element-caption\">Repr\u00e9sentation sch\u00e9matique de la valvuloplastie mitrale percutan\u00e9e par ballonnet<\/figcaption><\/figure>\n<ul class=\"wp-block-list\">\n<li><strong>Indications\u00a0<\/strong>\n<ul class=\"wp-block-list\">\n<li>St\u00e9nose mitrale s\u00e9v\u00e8re symptomatique (le plus souvent d\u2019\u00e9tiologie rhumatismale)\u00a0;<\/li>\n<li>St\u00e9nose s\u00e9v\u00e8re asymptomatique associ\u00e9e \u00e0 une hypertension pulmonaire (>\u00a050\u00a0mmHg) et \u00e0 une fibrillation atriale\u00a0;<\/li>\n<li>Absence d\u2019indications pour une chirurgie \u00e0 ciel ouvert\u00a0;<\/li>\n<li>Conditions anatomiques favorables\u00a0: feuillets mobiles, calcification minimale, atteinte limit\u00e9e de l\u2019appareil sous-valvulaire, profil morphologique favorable.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Contre-indications<\/strong>\n<ul class=\"wp-block-list\">\n<li>Thrombus de l\u2019atrium gauche ou de l\u2019auricule gauche\u00a0;<\/li>\n<li>R\u00e9gurgitation mitrale mod\u00e9r\u00e9e \u00e0 s\u00e9v\u00e8re\u00a0;<\/li>\n<li>Calcifications importantes\u00a0;<\/li>\n<li>\u00c9chec ant\u00e9rieur d\u2019une VMP.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Technique<\/strong>\n<ul class=\"wp-block-list\">\n<li>Un ballonnet est introduit dans l\u2019atrium gauche \u00e0 travers le septum interatrial, puis gonfl\u00e9 au niveau de l\u2019orifice mitral, en rompant ainsi les commissures fusionn\u00e9es.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"therapie-chirurgicale\">Th\u00e9rapie chirurgicale<\/h3>\n<ul class=\"wp-block-list\">\n<li><strong>Commissurotomie chirurgicale et plastie valvulaire conservatrice<\/strong>\n<ul class=\"wp-block-list\">\n<li>Cette option est indiqu\u00e9e chez les patients pr\u00e9sentant une anatomie d\u00e9favorable \u00e0 la VMP, un thrombus atrial gauche ou des l\u00e9sions valvulaires combin\u00e9es\u00a0;<\/li>\n<li>L\u2019intervention comprend la section des commissures, la correction des structures sous-valvulaires et, si n\u00e9cessaire, une annuloplastie.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Remplacement de la valve mitrale<\/strong>\n<ul class=\"wp-block-list\">\n<li>Le remplacement est indiqu\u00e9 en cas de d\u00e9formation valvulaire s\u00e9v\u00e8re, de calcifications importantes, de l\u00e9sions valvulaires combin\u00e9es et de st\u00e9nose r\u00e9cidivante apr\u00e8s des interventions r\u00e9p\u00e9t\u00e9es ;<\/li>\n<li>Outre la sternotomie m\u00e9diane, dans les cas o\u00f9 l\u2019anatomie et l\u2019\u00e9tat des vaisseaux des membres inf\u00e9rieurs le permettent, l\u2019intervention sur la valve mitrale peut \u00eatre r\u00e9alis\u00e9e par mini-thoracotomie droite avec circulation extracorporelle p\u00e9riph\u00e9rique.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Proth\u00e8ses m\u00e9caniques<\/strong>\u00a0: recommand\u00e9es chez les patients jeunes et d\u2019\u00e2ge moyen (jusqu\u2019\u00e0 60\u00a0ans) pr\u00e9sentant une esp\u00e9rance de vie longue. Elles n\u00e9cessitent la prise permanente d\u2019antagonistes de la vitamine\u00a0K et sont moins recommand\u00e9es aux femmes envisageant une grossesse.<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Proth\u00e8ses biologiques<\/strong>\u00a0: recommand\u00e9es chez les patients \u00e2g\u00e9s (65\u00a0ans et plus), ainsi que pour les femmes en \u00e2ge de procr\u00e9er. Elles ont une dur\u00e9e de vie limit\u00e9e en raison de la d\u00e9g\u00e9n\u00e9rescence structurelle et de la n\u00e9cessit\u00e9 potentielle d\u2019une r\u00e9intervention.<\/li>\n<\/ul>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/mechanical-and-biological-valves-left-right.webp\" alt=\"Valves m\u00e9canique (\u00e0 gauche) et biologique (\u00e0 droite)\"><figcaption class=\"wp-element-caption\">Valves m\u00e9canique (\u00e0 gauche) et biologique (\u00e0 droite)<\/figcaption><\/figure>\n<div>\n<h2 class=\"faq-title h2-article\" id=\"faq\">FAQ<\/h2>\n<div class=\"faq-section\">\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">1. Quelle est la cause principale de la st\u00e9nose mitrale\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Dans la plupart des cas, elle est due \u00e0 une cardiopathie rhumatismale entra\u00eenant un r\u00e9tr\u00e9cissement progressif de l\u2019orifice mitral. <\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">2. \u00c0 partir de quels crit\u00e8res la st\u00e9nose mitrale est-elle consid\u00e9r\u00e9e comme s\u00e9v\u00e8re\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Lorsque la surface de la valve mitrale est \u2264\u00a01,5\u00a0cm\u00b2, surtout en association avec des sympt\u00f4mes cliniques ou des signes d\u2019hypertension pulmonaire.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">3. Pourquoi les sympt\u00f4mes de la st\u00e9nose mitrale s\u2019aggravent-ils en cas de tachycardie\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">L\u2019acc\u00e9l\u00e9ration du rythme cardiaque raccourcit la diastole, augmente le gradient transmitral et \u00e9l\u00e8ve la pression dans l\u2019atrium gauche et les veines pulmonaires.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">4. Quelle est la principale m\u00e9thode de diagnostic de la st\u00e9nose mitrale\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">L\u2019\u00e9chocardiographie transthoracique est la principale m\u00e9thode d\u2019\u00e9valuation de la surface valvulaire, des gradients de pression et du degr\u00e9 d\u2019hypertension pulmonaire.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">5. Dans quels cas une \u00e9chocardiographie trans\u0153sophagienne (ETO) est-elle indiqu\u00e9e\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">L\u2019ETO est indiqu\u00e9e pour exclure la pr\u00e9sence d\u2019un thrombus dans l\u2019atrium gauche et pour pr\u00e9ciser l\u2019anatomie valvulaire avant une valvuloplastie percutan\u00e9e par ballonnet ou une intervention chirurgicale.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">6. Comment traiter une st\u00e9nose mitrale s\u00e9v\u00e8re symptomatique\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">La m\u00e9thode de choix est la valvuloplastie mitrale percutan\u00e9e par ballonnet \u00e0 condition d\u2019une anatomie valvulaire favorable. En pr\u00e9sence de contre-indications, un traitement chirurgical est recommand\u00e9.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">7. Quand la prise en charge chirurgicale de la st\u00e9nose mitrale est-elle pr\u00e9f\u00e9rable\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Une intervention chirurgicale est indiqu\u00e9e en cas d\u2019anatomie valvulaire d\u00e9favorable, de r\u00e9gurgitation mitrale significative ou de thrombus dans l\u2019atrium gauche.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">8. Comment prendre en charge les patients atteints de st\u00e9nose mitrale et de fibrillation atriale\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Le traitement repose sur le contr\u00f4le de la fr\u00e9quence ventriculaire et une anticoagulation obligatoire par des antagonistes de la vitamine\u00a0K en cas de st\u00e9nose mitrale rhumatismale.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">9. Pourquoi les anticoagulants oraux directs ne sont-ils pas recommand\u00e9s en cas de st\u00e9nose mitrale rhumatismale\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">En cas de st\u00e9nose mitrale rhumatismale, il n\u2019existe pas de preuves suffisantes d\u2019une efficacit\u00e9 et d\u2019une s\u00e9curit\u00e9 sup\u00e9rieures des AOD par rapport aux antagonistes de la vitamine\u00a0K.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">10. Quel type de proth\u00e8se valvulaire est pr\u00e9f\u00e9rable lors du remplacement de la valve mitrale\u00a0?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Chez les patients de plus de 65\u00a0ans, les bioproth\u00e8ses sont recommand\u00e9es. Chez les patients plus jeunes, les proth\u00e8ses m\u00e9caniques sont privil\u00e9gi\u00e9es, compte tenu de la n\u00e9cessit\u00e9 d\u2019un traitement anticoagulant \u00e0 vie.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<\/div>\n<p><script type=\"application\/ld+json\">\n    {\n    \"@context\": \"https:\/\/schema.org\",\n    \"@type\": \"FAQPage\",\n    \"mainEntity\": [\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Quelle est la cause principale de la st\u00e9nose mitrale\u00a0?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"Dans la plupart des cas, elle est due \u00e0 une cardiopathie rhumatismale entra\u00eenant un r\u00e9tr\u00e9cissement progressif de l'orifice mitral. \"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"\u00c0 partir de quels crit\u00e8res la st\u00e9nose mitrale est-elle consid\u00e9r\u00e9e comme s\u00e9v\u00e8re\u00a0?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"Lorsque la surface de la valve mitrale est \u2264\u00a01,5\u00a0cm\u00b2, surtout en association avec des sympt\u00f4mes cliniques ou des signes d'hypertension pulmonaire.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Pourquoi les sympt\u00f4mes de la st\u00e9nose mitrale s'aggravent-ils en cas de tachycardie\u00a0?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"L'acc\u00e9l\u00e9ration du rythme cardiaque raccourcit la diastole, augmente le gradient transmitral et \u00e9l\u00e8ve la pression dans l'atrium gauche et les veines pulmonaires.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Quelle est la principale m\u00e9thode de diagnostic de la st\u00e9nose mitrale\u00a0?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"L'\u00e9chocardiographie transthoracique est la principale m\u00e9thode d'\u00e9valuation de la surface valvulaire, des gradients de pression et du degr\u00e9 d'hypertension pulmonaire.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Dans quels cas une \u00e9chocardiographie trans\u0153sophagienne (ETO) est-elle indiqu\u00e9e\u00a0?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"L'ETO est indiqu\u00e9e pour exclure la pr\u00e9sence d'un thrombus dans l'atrium gauche et pour pr\u00e9ciser l'anatomie valvulaire avant une valvuloplastie percutan\u00e9e par ballonnet ou une intervention chirurgicale.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Comment traiter une st\u00e9nose mitrale s\u00e9v\u00e8re symptomatique\u00a0?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"La m\u00e9thode de choix est la valvuloplastie mitrale percutan\u00e9e par ballonnet \u00e0 condition d'une anatomie valvulaire favorable. En pr\u00e9sence de contre-indications, un traitement chirurgical est recommand\u00e9.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Quand la prise en charge chirurgicale de la st\u00e9nose mitrale est-elle pr\u00e9f\u00e9rable\u00a0?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"Une intervention chirurgicale est indiqu\u00e9e en cas d'anatomie valvulaire d\u00e9favorable, de r\u00e9gurgitation mitrale significative ou de thrombus dans l'atrium gauche.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Comment prendre en charge les patients atteints de st\u00e9nose mitrale et de fibrillation atriale\u00a0?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"Le traitement repose sur le contr\u00f4le de la fr\u00e9quence ventriculaire et une anticoagulation obligatoire par des antagonistes de la vitamine\u00a0K en cas de st\u00e9nose mitrale rhumatismale.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Pourquoi les anticoagulants oraux directs ne sont-ils pas recommand\u00e9s en cas de st\u00e9nose mitrale rhumatismale\u00a0?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"En cas de st\u00e9nose mitrale rhumatismale, il n'existe pas de preuves suffisantes d'une efficacit\u00e9 et d'une s\u00e9curit\u00e9 sup\u00e9rieures des AOD par rapport aux antagonistes de la vitamine\u00a0K.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Quel type de proth\u00e8se valvulaire est pr\u00e9f\u00e9rable lors du remplacement de la valve mitrale\u00a0?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"Chez les patients de plus de 65\u00a0ans, les bioproth\u00e8ses sont recommand\u00e9es. Chez les patients plus jeunes, les proth\u00e8ses m\u00e9caniques sont privil\u00e9gi\u00e9es, compte tenu de la n\u00e9cessit\u00e9 d'un traitement anticoagulant \u00e0 vie.\"\n            }\n        }\n    ]\n}<\/script><\/div>\n<div class=\"sources-list-block sources-list-hidden\" id=\"references\">\n<div class=\"sources-list-content\">\n<div class=\"sources-list-title\">\n<p class=\"small-text-bold text-black sources-list-title-text\">R\u00e9f\u00e9rences<\/p>\n<div class=\"sources-expand-button-wrapper-mobile\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n<div class=\"sources-list-items\">\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">1.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>VOKA 3D Anatomy & Pathology \u2013 Complete Anatomy and Pathology 3D Atlas [Internet] (VOKA 3D Anatomie et Pathologie \u2013 Atlas 3D complet d\u2019anatomie et de pathologie [Internet]). VOKA 3D Anatomy & Pathology (VOKA 3D Anatomie et Pathologie).<\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">Disponible \u00e0 l\u2019adresse\u00a0: https:\/\/catalog.voka.io\/<\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">2.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Praz F, et al. 2025 ESC\/EACTS Guidelines for the management of valvular heart disease [Recommandations 2025 de l\u2019ESC\/EACTS pour la prise en charge des valvulopathies]. Eur Heart J. 2025 Nov 21;46(44):4635\u20134736. doi:10.1093\/eurheartj\/ehaf194.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">3.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Otto CM, et al. 2020 ACC\/AHA Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines [Recommandations 2020 de l\u2019ACC\/AHA pour la prise en charge des patients atteints de valvulopathies\u00a0: rapport du comit\u00e9 conjoint de l\u2019American College of Cardiology et de l\u2019American Heart Association sur les recommandations de pratique clinique]. J Am Coll Cardiol. 2021 Feb;77(4):e25\u2013e197. doi:10.1016\/j.jacc.2020.11.018.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">4.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Harb SC, Griffin BP. Mitral valve disease: a comprehensive review [Maladie de la valve mitrale\u00a0: revue exhaustive]. Curr Cardiol Rep. 2017 Aug;19(8):73. doi:10.1007\/s11886-017-0883-5.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">5.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Kumar K, Simpson T. Transcatheter therapy for mitral valve stenosis [Traitement de la st\u00e9nose mitrale par voie transcath\u00e9ter]. Interv Cardiol Clin. 2024 Apr;13(2):271\u2013278. doi:10.1016\/j.iccl.2024.01.003.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">6.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Wunderlich NC, et al. Rheumatic mitral valve stenosis: diagnosis and treatment options [St\u00e9nose mitrale rhumatismale\u00a0: diagnostic et options th\u00e9rapeutiques]. Curr Cardiol Rep. 28 f\u00e9vr. 2019 ; 21(3) : 14. doi:10.1007\/s11886-019-1099-7.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">7.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Al-Taweel A, et al. Degenerative mitral valve stenosis: diagnosis and management [St\u00e9nose mitrale d\u00e9g\u00e9n\u00e9rative\u00a0: diagnostic et prise en charge]. Echocardiography. 2019 Oct;36(10):1901\u20131909. doi:10.1111\/echo.14495.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">8.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Robinson S, et al. The assessment of mitral valve disease: a guideline from the British Society of Echocardiography [\u00c9valuation de la valvulopathie mitrale : recommandations de la British Society of Echocardiography]. Echo Res Pract. 2021 Sep 27;8(1):G87\u2013G136. doi:10.1530\/ERP-20-0034.<\/cite><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sources-expand-button-wrapper\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>La st\u00e9nose mitrale (SM) est un r\u00e9tr\u00e9cissement pathologique de l\u2019orifice mitral qui entra\u00eene une alt\u00e9ration du remplissage diastolique du ventricule gauche, ainsi qu\u2019une augmentation de la pression dans l\u2019atrium gauche et la circulation pulmonaire. 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